Are We Giving Boys a Voice?

by Christine Wekerle, PhD

Helping male victims of child sexual abuse speak out and asking ourselves as professionals some serious questions: Are we ready to hear about boys’ sexual violence victimization? Are we ready to ask the question and prepared to offer the empathic response victims are hoping to hear?

Child sexual abuse (CSA) is a difficult topic for victims to confront. It challenges male victims much more to realize they live in a society that still believes in myths about men and boys, such as males cannot be rape victims, that they do not have emotional problems and can toughen out any situation, and that they are not as wonderful as nurturers as any other gender.  As a society, we still have a way to go towards encouraging men and boys to be both self-compassionate and compassionate towards others.

The Difficult Conversation
Sexual violence against children has been defined in various terms that include rape, being forced to engage in sexual activity of any kind and being forced to watch others engage in sexual activity. This form of abuse is not only terrifying and confusing for the child, but its effects can last long into adulthood. Survivors of sexual abuse often have feelings of shame or disgust, poor body image, problems with intimacy and addiction behaviours that can affect them well into adulthood. Long-term effects can also mean that many people who have experienced CSA engage in risky sexual behaviours, putting their mental wellbeing and physical health at risk.

Although all of us are aware that sexual violence against children is real and devastating for victims, families, and communities, it remains a very difficult conversation.  Many children never vocalize the harm done to them or may wait many years before speaking up.  Fear of the stigma translates to some victims never telling anyone in their lifetime. As professionals, we must bear a tolerance for distress to ensure we are not participating in gaze aversion when we could be addressing male victimization directly.

The prevalence of sexual violence is shocking. A working cross partnership involving the United Nations and the World Health Organization – named the Global Partnership to End Violence Against Children – estimates that more than 200 million children worldwide have experienced sexual violence. The NSPCC estimates that 20% of children in the UK have been abused in this way. There is concern that male victims experience greater injury with the use of greater force than do female victims, as well as their victimization occurring at younger ages, in the preschool years.  There is overlap among maltreatment types. As males tend to be victims of physical abuse at higher levels, this should be a signal to professionals to be sure to query sexual violence. In a similar vein, neglect creates situations of low parental monitoring and exposure to unknown and dangerous persons. Sexual violence thus occurs as secondary to neglect. For professionals, a comprehensive evaluation of all forms of child abuse and neglect is a must for prevention, with recent work pointing to frequent parental use of spanking as a “red flag” (see Afifi & Romano, 2017). Mandatory reporting considerations need to recognize this overlap and advance a comprehensive maltreatment assessment model that emphasizes ongoing monitoring and ongoing duties to report.

Helping Boys Speak Out
Speaking out is a big ask for anyone who has been through sexual trauma and this is especially true for males, who are far less likely to disclose a history of CSA. Research shows that male survivors are more reluctant to vocalize their abuse than females, with a very wide range of reported rates, with some studies showing higher rates than the generally accepted rate of less than 10% (Moynihan, Mitchell, Pitcher, Havaei, Ferguson, & Saewyc, 2018). Without support, people who have been abused are at risk of isolation and negative consequences for their health and wellbeing. Whilst female victimization is undoubtedly more common, male victimization presents a complex and distinct set of challenges.

To address these challenges I have been leading a team in Canada who are undertaking an innovative new set of studies in which male survivors of CSA are put at the fore, active on social media with #CIHRTeamSV (see https://www.researchgate.net/project/Understanding-health-risks-and-promoting-resilience-in-male-youth-with-sexual-violence-experience-CIHR-Team-Grant-TE3-138302). By exploring experiences of men and boys who have been victims of this violence, we hope to help develop ways to better intervene, and ultimately prevent sexual violence. Our team has been looking at prevalence, resilience, and interventions. In a recent review on interventions, Moynihan, Pitcher, and Saewyc (2018) found that most programs were gender-specific, targeting girls and young women with just one being for boys and young men only.

The Effects of Abuse on Young Males
CSA is a common experience of young people who were involved in welfare services in Canada, as our recent study, which was funded by the Canadian Institutes for Health (CIHR), has shown (Wekerle, Goldstein, Tanaka, & Tonmyr, 2017). In the study of almost 300 youths aged 14–17, 38.3% had experienced this type of abuse. All of the young people in this study – the first to evaluate motives for sexual behaviours in young people who have experienced sexual abuse – were sexually active. A history of sexual abuse was more commonly linked to risky sexual behaviours (including multiple partners and unprotected sex) for both genders. Compared with males who had not experienced sexual violence as a child, victims of this abuse were more likely to use sex as a coping mechanism to deal with negative emotions and to seek peer approval, using sex to manage distress. We argue that this fits with conforming to traditional male stereotypes.

A recent study from our team used Quebec population data of youth with a substantiated CSA report and who have either aged out of child welfare care (average age = 18 years) or remain in care (average age = 18 years) (Daigneault, Esposito, Bourgeois, Hébert, Delaye, & Frappier, 2017).  Mental health service needs were five times greater for youth with CSA experiences than the general population, and this frequent service need did not differ between the aging out versus younger youth.  There was an increase in need for physical health services from ages 17 to 18 (on average 3.22 more consultations). This suggests that health needs will continue post exit from child welfare. For males, instead of acknowledging and dealing with the range of emotions that CSA can inflict on a young person, and promptly taking care of physical health issues, males may retreat into anger and cycles of negative health risk behaviours. For youth who have made it into a service system, a transition plan for health seems essential. A key theme from CIHRTeamSV is that emotion regulation is key to determining healthy coping strategies, as well as sexual and relationship behaviours in adolescence. We need to be ready to consider the particular needs of males who have experienced child sexual abuse.

Distressingly, the research also highlights that victims of childhood abuse also experience sexual coercion from partners, and that more needs to be done to understand how to help young people avoid re-abuse in future relationships. The work of CIHRTeamSV also focuses on resilience: we are currently developing an app which contains games that might be relevant for male youth who struggle to manage emotions and behaviour. We need to meet male youth victims where they are at, in the worlds they inhabit, to be successful at that critical outreach.

Learning to Listen
I advocate that in order to build the necessary support networks around boys that are vital to helping young people cope, we must be ready to listen to males and accept that they too can be victims. As the overwhelming majority of sex abuse is perpetrated by men, we are challenged in how we view “maleness.” Our contemporary conversation reflects this in developing a male #MeToo approach to allow all victims to come forward, and movies and documentaries such as “Spotlight”, “The Mask We Live in”, and “The Heart of a Man” are putting this conversation into broader view. Cultural and societal ideas of masculinity make it more difficult for young men to seek help for emotional issues, which may play a role in the high rates of suicide seen in this demographic and the ten-fold increase in risk in being hospitalized for a physical health problem compared with people in the general population. Fixed, long-standing stereotypes around “alpha” males – so-called toxic masculinity – make it difficult for men to admit that they have been abused and reach out for help and nurturance, rather than resort to destructive approaches to numb the pain. These stereotypes affect us all – for example, child welfare case workers were found to note less often that males have experienced emotional harm as a result of their abuse (Wekerle et al., 2017). This is a disconnect with research showing that many male victims experience symptoms of post-traumatic stress disorder (PTSD), yet are more than twice as likely to seek treatment for mental health problems than female victims. As professionals, we need to ask ourselves if we are preparing our pediatric clients for what they may encounter as young adults and across adulthood. Healthcare professionals need to bring youth into the wellness visit strategy that goes beyond following a vaccination schedule. Violence and mental health have evidence-based inoculations as well (Daigneault, Vézina-Gagnon, Bourgeois, Esposito, & Hébert, 2017).

The Way Forward
Our research points to a number of actions that need to be taken in order for male victimisation to be addressed. These include acknowledging sex and gender and accepting that males can also be victims, having a trauma-informed healthcare provision, ensuring safety in young people’s relationships, and tackling sexual violence from a public health perspective (see Wekerle, 2017). We can advance boys’ initiatives without diminishing the important strides that need to be made for all victims. That said, the United Nation’s ratified Sustainable Development Goal (5) on sexual violence is specific to females, as in most parts of the world, female victimization is higher than male victimization.

By bringing male victims of sexual violence to the fore of our research, we give hope to boys and men – and those who care for them – that they will find support to cope with their experiences and that researchers are paying attention and are willing to listen. Confiding in trustworthy adults is the most effective way that children can be helped out of sexual violence. Support from education, social, and health services is the best way for survivors to be supported to deal with ongoing psychological effects as a result of this violence. Together, we can bring light to darkness, hope to helplessness, resilience to wrongs, and thriving to surviving.


This article is based on an article originally published online by Research Features at researchfeatures.com/2018/05/29/giving-voice-male-victims-child-sexual-abuse/

References
Afifi, T., & Romano, E. (Eds.). (2017). Moving beyond the spanking debate: A call to action [Special issue]. Child Abuse & Neglect, 71, 1–104

Daigneault,I, Esposito, T., Bourgeois, C., Hébert, M., Delaye, A., & Frappier, J.-Y. (2017). Health service use of sexually abused adolescents aging out of care: A Matched-cohort study. International Journal of Child and Adolescent Resilience, 5(1), 53–66.

Daigneault, I., Vézina-Gagnon, P., Bourgeois, C., Esposito, T., & Hébert, M. (2017) Physical and mental health of children with substantiated sexual abuse: Gender comparisons from a matched-control cohort study. Child Abuse and Neglect, 66, 155–165.

Moynihan, M., Mitchell, K., Pitcher, C., Havaei, F., Ferguson, M., & Saewyc, E. (2018). A systematic review of the state of the literature on sexually exploited boys internationally. Child Abuse and Neglect, 76, 440–451.

Moynihan, M., Pitcher, C., & Saewyc, E. (2018). Interventions that foster healing among sexually exploited children and adolescents: A systematic review. Journal of Child Sexual Abuse, 27, 403–423.

Wekerle, C. (2017, November 1). Specially Commended Institute of Healthy Development and Child and Youth Health (IHDCYH) Video Talks 2017: Boys’ and men’s health: Child sexual abuse prevention [Video file]. Retrieved from https://www.youtube.com/watch?v=k1qvzGhOWU4

Wekerle, C. Goldstein, A. L., Tanaka, M., & Tonmyr, L. (2017). Childhood sexual abuse, sexual motives, and adolescent sexual risk-taking among males and females receiving child welfare services. Child Abuse and Neglect, 66, 101–111.

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